Quick answer: Texas ECI (Early Childhood Intervention) is a state program for children from birth to 36 months who have a qualifying developmental delay or diagnosis. It starts with a no-cost evaluation, and other services are billed on a sliding scale based on family size and income. Private pediatric occupational therapy is available at any age, with no delay threshold to meet. Your family picks the therapist and schedule. Many Houston families use ECI before age 3, private OT after age 3, or both.
If your pediatrician mentioned “ECI” at a well visit, or your toddler isn’t reaching milestones the way you expected, you’ve probably found two paths: the state’s Early Childhood Intervention program and private pediatric occupational therapy. Both can help. They’re built differently, though, and knowing those differences can save your family weeks of waiting and confusion.
I’m a pediatric occupational therapist with more than 25 years of experience, and I now provide in-home OT across Greater Houston. Here’s how I explain the two options to parents.
What Is ECI in Texas?
Early Childhood Intervention is a statewide program run by Texas Health and Human Services for children from birth to 36 months. It serves infants and toddlers with developmental delays or disabilities through local ECI programs across the state.
An ECI team can include occupational therapists, physical therapists, speech-language pathologists, early intervention specialists, and other professionals. According to Texas HHS, most ECI services happen at home or in other places a child spends time regularly, like a childcare center. The focus is on coaching parents and caregivers during everyday routines.
Who Qualifies for ECI?
Texas HHS lists three ways a child can be eligible for ECI:
- A developmental delay of 25% or more in one or more areas of development (33% if the delay is only in communication)
- A medically diagnosed condition that is likely to cause a developmental delay
- An auditory or visual impairment as defined by the Texas Education Agency
Anyone can refer a child to ECI, including a parent, grandparent, childcare provider, or doctor. You don’t need a physician’s referral to ask for an evaluation.
What Does ECI Cost?
Some ECI services are always free to families: the evaluation, the assessment, case management, development of the child’s plan (the Individualized Family Service Plan, or IFSP), and interpreter services. Other services are billed on a sliding fee scale based on family size and income. Disability Rights Texas notes that if a family can’t pay, services must still be provided at no charge. With your permission, ECI may also bill Medicaid or private insurance.
What Is Private Pediatric Occupational Therapy?
Private pediatric OT is delivered by a licensed occupational therapist in a clinic or, with practices like ours, in your home. There’s no age cutoff and no percentage-of-delay threshold. If your child is struggling with everyday skills like feeding, dressing, handwriting, sensory regulation, or play, a private OT can evaluate and treat.
Under Texas occupational therapy rules, an OT can evaluate a child without a referral. Ongoing treatment for a medical condition requires a referral from a licensed referral source, such as your pediatrician. Many insurance plans also have their own referral or prior-authorization rules. We check all of this for families before services start.
ECI vs. Private OT: Side-by-Side Comparison
| Texas ECI | Private Pediatric OT | |
|---|---|---|
| Ages served | Birth to 36 months | Any age, from infancy through the teen years |
| Eligibility | 25% delay (33% if communication-only), a qualifying diagnosis, or a vision/hearing impairment | Any functional concern a licensed OT can address. No threshold. |
| Where therapy happens | Mostly at home or in childcare settings | Clinic or in-home, depending on the provider (Collab is 100% in-home) |
| Cost to families | Evaluation, assessment, case management, and IFSP at no cost; other services on a sliding fee scale | Insurance, Texas Medicaid, or private pay, depending on the plan and provider |
| Therapy style | Team-based caregiver coaching during daily routines | Direct one-on-one therapy plus parent coaching |
| Choice of therapist | Assigned by your local ECI program | You choose the provider |
| What happens at age 3 | ECI services end, with transition planning to school or community programs | Therapy continues with no age-based interruption |
What Happens When ECI Ends at Age 3?
ECI services end on a child’s third birthday. Your ECI team is required to start transition planning before then. Many children then move to their public school district’s early childhood special education program, a preschool, Head Start, or a childcare setting.
Parents are often surprised to learn that school-based therapy and private therapy have different goals. Under federal special education law, school OT is a “related service” to help a child benefit from their education. It focuses on what the child needs at school. Private OT can work on the whole picture, including mealtimes, dressing, bath time, sleep routines, and behavior at home. That’s why many families add private OT around age 3 to keep progress going.
Which Option Is Right for My Child?
- Under 3 and you’re seeing clear delays? Contact your local ECI program. The evaluation is free, and you don’t need a referral.
- Under 3 but didn’t qualify for ECI? A child can miss the 25% cutoff and still struggle every day. A private OT evaluation can find specific skill gaps and treat them.
- Turning 3 soon, or already 3 or older? Private OT gives you continuity. There’s no gap while school evaluations are scheduled, and therapy covers life at home, not just the classroom.
- Want more support than you’re getting now? Some families use private OT alongside ECI or school services. If you do, let each team know so everyone works toward the same goals, and confirm coverage rules with your insurance plan.
- How long does pediatric OT take?
Not sure where your child fits? That’s exactly what an evaluation is for. See what happens at a pediatric OT evaluation, or check the signs a child may need occupational therapy.
How Do Houston Families Start Private In-Home OT?
Collab Therapeutic Services brings pediatric occupational therapy into your home across Greater Houston, including Houston, Katy, Sugar Land, Pearland, Cypress, Spring, and The Woodlands. Getting started takes three steps:
- Call or request an intake. Tell us your child’s age, what you’re noticing, and your insurance.
- We verify your benefits. We confirm coverage, referral needs, and any prior authorization. Texas Medicaid is accepted.
- We schedule the evaluation at your home. Your child is assessed where daily life happens, and you get a clear, family-friendly plan.
Frequently Asked Questions
Is ECI free in Texas?
Partly. The evaluation, assessment, case management, and development of your child’s IFSP are provided at no cost. Other ECI services are billed on a sliding fee scale based on family size and income, and ECI may bill Medicaid or private insurance with your permission.
What age does ECI stop in Texas?
ECI serves children from birth to 36 months. Services end on the child’s third birthday, and the ECI team helps families plan the transition to school, preschool, or community programs before then.
Can my child get private OT if they didn’t qualify for ECI?
Yes. ECI requires a specific level of delay or a qualifying diagnosis. Private pediatric OT has no percentage threshold. If your child is struggling with everyday skills, a licensed OT can evaluate and treat them.
Can my child have ECI and private OT at the same time?
Some families combine them to get more support. Tell both teams so goals are coordinated, and check your insurance plan’s rules, since coverage for overlapping services varies.
Do I need a referral for ECI or private OT in Texas?
Anyone, including a parent, can refer a child to ECI. For private OT, Texas rules allow an OT to evaluate without a referral, but ongoing treatment for a medical condition requires a referral from a licensed source like your pediatrician. Your insurance may have its own requirements.
Related Guides for Houston Parents
- Signs your child may need occupational therapy
- What happens at a pediatric OT evaluation?
- Fine motor skills by age: a parent’s milestone checklist
- Does Texas Medicaid cover pediatric OT?
- In-home vs. clinic pediatric OT: which is right for your child?
Have Questions About ECI, School OT, or Private OT? Let’s Talk.
Whether your child is 18 months or 8 years old, we can help you figure out the next step. Call Collab Therapeutic Services at (832) 232-3611 or request an intake call to schedule an in-home evaluation anywhere in Greater Houston. No referral is needed to schedule the evaluation. For Texas Medicaid, a signed order from your child’s doctor is required, and we help coordinate it.
Sources: Texas HHS – ECI Information for Families; Disability Rights Texas – What Is Early Childhood Intervention?; Texas Administrative Code, Occupational Therapy Rules, Provision of Services. Last reviewed September 2026.
About the Author
Phincy Thomas, OTR/L, is the founder of Collab Therapeutic Services, LLC and a licensed occupational therapist with more than 25 years of pediatric experience. She provides in-home occupational therapy to children across Greater Houston, helping families build real-life skills where they matter most — at home. This article is for educational purposes and is not a substitute for an individualized evaluation.